What if I lost my grip and she just….fell? How would she land? Would she scream? Would I scream?

The horrifying thoughts kidnapped Lauren’s mind as she held her 6-month old daughter, Kate, on her balcony in Hoboken, N.J., four stories up.

Though her pregnancy was smooth, Lauren, 38, struggled with first-time motherhood. Her milk refused to come in. Her new job was relentless (she started the high-powered position just 7 weeks within giving birth). And Kate was colicky. At night, between feedings, Lauren was terrorized by nightmares about killing her daughter by accident—rolling over her in bed or snapping her neck as she tried to dress her.

The journalist had anxiety throughout her 20s and 30s, but it was a manageable anxiety. It was the kind she felt. A tingly stomach, clammy hands, a speedy heartbeat. But this was all happening in her head. And worse, she couldn’t seem to control it.

Lauren is hardly alone. In fact, she’s part of a growing number of new moms struggling with postpartum anxiety. It’s at the heart of a recently released book, Good Moms Have Scary Thoughts, on the lips of famous mothers (Alanis Morissette revealed that she had anxious thoughts over her third child) and the subject of new research (a meta analysis published in The Journal of Clinical Psychiatry urged that more anxiety screenings were needed for pregnant women and new moms.)

So What Is Postpartum Anxiety, Exactly?

Postpartum anxiety (PPA) impacts about 15 percent of women—nearly as many as postpartum depression (PPD). But unlike PPD, postpartum anxiety sits under a complex umbrella of anxiety disorders including postpartum obsessive-compulsive disorder (worrying, and often troublesome, thoughts she can’t shut off) and postpartum post-traumatic stress disorder (anxiety tied to a difficult labor; in this instance, the mother relives a painful birth).

In a nutshell, if postpartum depression is known colloquially as “baby blues,” then postpartum anxiety would be colored red—a loop of fear, worry, stress, and intrusive thoughts. Those who have it in pregnancy and more likely to have it after birth. In fact, there’s a term for that too: perinatal mood and anxiety disorders (PMADs).

PMAD affects around 1 in 5 women, says Tiffany A. Moore Simas, MD, a professor of obstetrics and gynecology, co-director of the Maternity Center, and medical director of Lifeline4Moms at the University of Massachusetts Medical School/UMass Memorial Health Care. Perinatal anxiety symptoms can include everything from panic attacks to restless sleep to repeated thoughts of scary things happening to the baby.

And a frustrating reality: There is no—we repeat no—perinatal specific screening tool for generalized anxiety disorder.

Thoughts of hurting one’s baby without any intention to act on these thoughts are not uncommon among new mothers, says Sarah Homitsky, MD, director of the Alexis Joy D’Achille Center for Perinatal Mental Health at AHN West Penn Hospital in Pittsburgh.  These thoughts can be symptoms of postpartum obsessive compulsive disorder (OCD),

Who Is at Risk?

Like Lauren, many women who had or have anxiety before conceiving are at increased risk of developing the postpartum form. And anxiety disorders, in general, affect more women than men, according to a study in the Journal of Affective Disorders. The prevalence of anxiety disorders during pregnancy and the early postpartum period (15.8% and 17.1% respectively) exceeded that of depression (3.9% and 4.8% respectively).

  • Family history of anxiety
  • Previous history of other perinatal mental health issues, including depression
  • Personal or family history of a perinatal mental health issue
  • History of thyroid dysfunction (including diabetes)
  • Previous pregnancy or infant loss

How Does It Differ from Postpartum Depression?

Postpartum anxiety doesn’t attract as much attention—from society or by doctors. Unlike postpartum depression, it’s not recognized by the Diagnostic and Statistical Manual of Mental Disorders, the gold standard of reference for mental health professionals. “We don’t do as good a job at screening new mothers for anxiety disorders,” says Dr. Homitsky, who finds that it’s more common in her clinic than postpartum depression.

In postpartum depression, mothers may feel detached and disconnected from their new babies. In postpartum anxiety, they’re consumed by thoughts of their babies. There also can be a fair amount of overlap between the two conditions, says Dr. Homitsky. You can feel sad, overwhelmed, and disinterested in the baby one minute, and consumed and excessively worried the next.

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How to Spot the Signs and Symptoms

The symptoms of postpartum anxiety, in addition to the hard-to-shake intrusive thoughts, include:

  • restlessness or feeling on edge
  • thinking constantly about the safety of the baby
  • fearing that you’ll do something to harm the baby
  • feeling overwhelmed by the demands of motherhood
  • growing irritable or edgy with others
  • snapping at one’s children and experiencing guilt afterwards

Could It Be Postpartum OCD?

The specific kind of anxiety that Lauren was experiencing was postpartum OCD. The condition affects around 6% of mothers and can be associated with thoughts of hurting the baby, Dr. Homitsky says. “It’s not uncommon for women to develop obsessive and anxious thoughts that get stuck in their heads,” she says. Mothers typically find the thoughts, called ego-dystonic thoughts, disturbing and unacceptable, she says.  “For instance, a mother could persist in having might be of drowning her baby in the bathtub, although she has no intention of doing so and she feels anxious to even give the baby a bath,” Dr. Homitsky says.

“Women have all sorts of thoughts in the context of a new child,” says Michael O’Hara, PhD, professor of psychological and brain sciences at the University of Iowa and a specialist in postpartum depression. “Some of them can be scary, but it is very, very uncommon for a woman to act on these thoughts.”

Much less common than postpartum anxiety is a condition known as postpartum psychosis, which is characterized by ego-syntonic thoughts, says Dr. Homitsky. “In this condition, the mother may have thoughts of hurting her baby and the thoughts are not upsetting to her,” she says. “If you speak with a mother who is psychotic, she may say she hears voices telling her to hurt her child.” Only about 1 in 1,000 women experience postpartum psychosis.

Clinicians need to be able to distinguish between a woman who has postpartum anxiety and one with psychosis who is hearing voices telling her to harm her baby and feeling that this is the right thing to do, Dr. O’Hara says. “The mental health community is starting to understand all this a little better, but it doesn’t surprise me that there is still misunderstanding,” he says.

Know Your Treatment Options

Some mothers just don’t tell their doctors when they are feeling postpartum anxiety. In one study, more than half the participants reported having postpartum mood disorder symptoms, yet one in five did not disclose this to a health care provider. About half the women reported at least one barrier that they said made it difficult or impossible for them to seek help.

One reason is that stigma abounds: Recently, when one Alabama mother of two visited her obstetrician, she mentioned that she had been having unwelcome thoughts of ending her life and her baby’s.  She made it clear to the physician that she was repulsed by the thoughts and would never act on them. But still, her children (ages two years and two months old) were removed from her home and placed in a relative’s care, according to an article in Motherly.

Despite that case, it’s important for a new mother with anxiety to seek help, says Dr. Simas. “Moms should turn to their obstetrician, their primary care doc, their therapist (if they have one), and their family and friends,” she advises. “She should keep reaching out until she gets the help she needs.”

Treatment for postpartum anxiety includes certain forms of psychotherapy, Dr. Homitsky explains. Both cognitive behavioral therapy (CBT) and Interpersonal Psychotherapy (IPT) can be helpful, and some oral medications can be effective as well.

The American College of Obstetricians and Gynecologists (ACOG) recommends that all women be screened for depression and anxiety at least once during the perinatal period. ACOG, along with the Council on Patient Safety in Women’s Health Care, puts out a maternal mental health patient safety bundle meant to help obstetricians detect and treat mental health conditions like anxiety. It’s at https://safehealthcareforeverywoman.org/.

We can’t underscore it enough: it’s crucial to recognize that intrusive thoughts are especially common with perinatal anxiety. And Dr. Simas adds that it’s relatively rare for a mom to be separated from her children. The Alabama mom whose children were taken from her is currently seeing a psychiatrist, counselor, and psychologist. She and her husband attend parenting classes five days a week. The couple, says Motherly, hopes to have their children back at home with them by Christmas.

And what about Lauren? After three months of CBT, her symptoms eased. She had the benefit of a supportive husband and family who assumed the parenting load as she sought therapy. “I know that not everyone is as lucky as I am to have that option.”


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Last Updated: Dec 6, 2019